BACKGROUND: The recanalization success rate of blunt and vague stump (stumpless) CTO lesions, especially those with a side branch arising from the occlusion, has been significantly lower than that of tapered stump CTO lesions. Intravascular ultrasound (IVUS) may be useful to identify the occlusion point and may facilitate the passage of guide-wires. We evaluated the clinical feasibility of the IVUS-guided wiring technique for stumpless CTO lesions. METHODS: Thirty-one consecutive patients (7 women; mean age: 61.0 ± 8.9 years) with 32 lesions were enrolled. The IVUS catheter was introduced into the side branch and it was withdrawn from the side branch to find the entry point of the occlusion, trying to engage another stiffer guide-wire on the occlusion point with the help of real-time IVUS imaging. RESULTS: The left anterior descending artery was the most common target-lesion location (22 lesions [69%]). CTO lesions were successfully reopened in 26 lesions (81%). IVUS guidance allowed confident navigation of the stiff guide-wires. The entry point could not be identified in one, and full guide-wire passage was impossible in 4 with the IVUS guidance; TIMI 3 flow could not be achieved even after stent deployment in 1. Although procedure-related complications developed in 8 lesions (25%), no events were serious. Emergent operation was not needed and death or fatal myocardial infarction did not develop during or after the procedures. CONCLUSIONS: The IVUS-guided wiring technique is useful and safe for the recanalization of stumpless CTO lesions and might be a valuable tool for the recanalization of complex CTO lesions.
BACKGROUND: The recanalization success rate of blunt and vague stump (stumpless) CTO lesions, especially those with a side branch arising from the occlusion, has been significantly lower than that of tapered stump CTO lesions. Intravascular ultrasound (IVUS) may be useful to identify the occlusion point and may facilitate the passage of guide-wires. We evaluated the clinical feasibility of the IVUS-guided wiring technique for stumpless CTO lesions. METHODS: Thirty-one consecutive patients (7 women; mean age: 61.0 ± 8.9 years) with 32 lesions were enrolled. The IVUS catheter was introduced into the side branch and it was withdrawn from the side branch to find the entry point of the occlusion, trying to engage another stiffer guide-wire on the occlusion point with the help of real-time IVUS imaging. RESULTS: The left anterior descending artery was the most common target-lesion location (22 lesions [69%]). CTO lesions were successfully reopened in 26 lesions (81%). IVUS guidance allowed confident navigation of the stiff guide-wires. The entry point could not be identified in one, and full guide-wire passage was impossible in 4 with the IVUS guidance; TIMI 3 flow could not be achieved even after stent deployment in 1. Although procedure-related complications developed in 8 lesions (25%), no events were serious. Emergent operation was not needed and death or fatal myocardial infarction did not develop during or after the procedures. CONCLUSIONS: The IVUS-guided wiring technique is useful and safe for the recanalization of stumpless CTO lesions and might be a valuable tool for the recanalization of complex CTO lesions.
Authors: Nicola Ryan; Nieves Gonzalo; Philip Dingli; Oscar Vedia Cruz; Pilar Jiménez-Quevedo; Luis Nombela-Franco; Ivan Nuñez-Gil; María Del Trigo; Pablo Salinas; Carlos Macaya; Antonio Fernandez-Ortiz; Javier Escaned Journal: Int J Cardiovasc Imaging Date: 2017-02-14 Impact factor: 2.357
Authors: Yeon-Hwa Kim; Seung Hwan Hwang; Chur Hoan Lim; Hye Mi An; Hee Jong Kim; Se Gwon Moon; Won Yu Kang; Sun Ho Hwang; Weon Kim; Wan Kim Journal: Korean Circ J Date: 2012-09-27 Impact factor: 3.243
Authors: Judit Karacsonyi; Khaldoon Alaswad; Farouc A Jaffer; Robert W Yeh; Mitul Patel; John Bahadorani; Aris Karatasakis; Barbara A Danek; Anthony Doing; J Aaron Grantham; Dimitri Karmpaliotis; Jeffrey W Moses; Ajay Kirtane; Manish Parikh; Ziad Ali; William L Lombardi; David E Kandzari; Nicholas Lembo; Santiago Garcia; Michael R Wyman; Aya Alame; Phuong-Khanh J Nguyen-Trong; Erica Resendes; Pratik Kalsaria; Bavana V Rangan; Imre Ungi; Craig A Thompson; Subhash Banerjee; Emmanouil S Brilakis Journal: J Am Heart Assoc Date: 2016-08-20 Impact factor: 5.501